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Diabetes affects most
organs and tissues in the body including the eyes. Diabetic
retinopathy refers to the changes in the retina and its
circulation causing fluid leakage, blockage of blood supply, new
and abnormal blood vessel formation and haemorrhage. This
results in a gradual or sometimes rapid loss of visual function.
It is a chronic progressive condition with no permanent cure. It
is generally divided in three stages: background, pre-proliferative
and proliferative. The affection of the macula generally
accompanies the retinopathy, and is known as maculopathy which
may be exudative, ischaemic or mixed type.
Nearly all diabetics get
it . The clinical picture, severity and the evolution may vary
between different individuals and also the type of diabetes. It
is more prevalent in insulin dependent diabetics than non
insulin dependent. It is the leading causes of blindness in
persons of working age especially in the developed countries.
Retinopathy becomes more prevalent and worse with increasing
duration of diabetes. Poorly controlled diabetes, high blood
pressure, kidney problems, smoking etc. increase the risk.
Diabetes is the
underlying cause, this affects the blood, blood vessels as well
as metabolism of tissues. This causes the nutrition of retina
and other tissues to suffer, which in turn causes a reduction in
visual function. Over and above this haemorrhage in front of the
retina and in the vitreous cavity can block the vision, so also
retinal detachment can develop.
Diminution of vision,
this may be gradual or sudden. Once the vision has reduced due
to poor function of the retina it usually can not improve even
with treatment. Floaters or shadows can be caused by haemorrhage.
The vision can also reduce due to cataract which can develop at
an earlier age in diabetics.
- CAN
I DO ANYTHING TO HELP MYSELF?
Definitely, you can make
a lot of difference by doing the following : tight control of
diabetes, good control of high blood pressure, avoiding smoking,
keeping regular appointments with your doctor and the eye
specialist.
It is important to
remember that diabetes and diabetic retinopathy can not be cured
but can be controlled. Tight control of diabetes & control
of other accompanying conditions such as high blood pressure,
heart problems, obesity etc. is the first step. The next step is
early diagnosis which can be accomplished by regular eye check
and diabetic eye screening. The mainstay of treatment is
retinal laser photocoagulation and is commenced when the
retinopathy reaches a certain stage.[More..5] Laser treatment is not a
one off treatment and is repeated as and when required in course
of time. Regular eye examination is therefore crucial. Surgery
is undertaken in advanced cases with unresolving haemorrhage, or
other complications including retinal detachment. Often
special tests such as fluorescein angiogram are done to assess
the retinal circulation which help to make decisions about
treatment.
- ARE
THERE ANY ADVERSE EFFECTS OF LASER TREATMENT?
Yes, the main ones are:
1. Reduction in the field of vision which may have
implications on driving eligibility. 2. Alteration in colour and
night vision. 3. Some times reduction of vision in the short
term. Besides these the major limitation is that the
retinopathy and the vision can keep worsening regardless of
laser treatment.
Although laser treatment is not a complete answer to the problem
it is the best available mode of treatment today and can
preserve useful vision in most cases. |
click on the pictures to
enlarge them
normal retina
proliferative diabetic
retinopathy
( the
retinal picture is digitally reconstructed from picture of
normal retina and does not belong to any patient)
for patients
to undergo retinal laser treatment (printer friendly)
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